Abdominoplasty (Tummy Tuck) and Body Contouring

Tummy Tuck (Abdominoplasty) is an operation for removing excess skin, stretch marks, and fat from the abdomen. At the same time, the umbilicus (belly button) is repositioned and the muscles of the abdomen (rectus abdominis muscles) are tightened and their position is restored to correct diastasis recti (separation of the abdominal muscles) with abdominal bulge. The scar is placed low on the abdomen at the pubic hair line, similar to a c-section, so it can be easily hidden with underwear or a bikini. Tummy tuck is usually combined with fat reduction by liposuction of the "love handles" or waistline to remove common areas of excess fat. A midline depression can also be sculpted with liposuction to show the muscles and enchance the appearance of a “6 pack”. Patients undergoing abdominal hernia repair (umbilical hernia or ventral hernia or incisional hernia) might also consider having a tummy tuck at the same time as the hernia repair to avoid extra operations and improve abdominal contour.

Patients often benefit from the experience of two board certified plastic surgeons working together to improve safety and efficiency. Unlike many surgeons who have physician assistants helping or performing parts of the operation, top Boston Mass board certified plastic and cosmetic surgeons Dr. Taylor and Dr. Sullivan work together to perform tummy tuck operations. They are also among very few plastic surgeons in the Boston area to use the latest and most effective medications for pain control and opioid reduction, including Exparel® (liposomal bupivacaine). With their carefully planned protocols, patient safety is the highest priority and patients can often avoid taking or reduce postoperative opioid or narcotic pain medications. The operation usually takes approximately two to two and a half hours. Patients recover quickly with limited discomfort and are able to leave Mount Auburn Hospital on the same day as the operation. Dr. Taylor and Dr. Sullivan are selective about choosing patients for a tummy tuck operation. If you have excess skin, stretch marks, hernia, diastsis, and fat deposits of your abdomen, consider meeting with Dr. Taylor and Dr. Sullivan, Boston plastic and cosmetic surgeons, to determine if you would be a good candidate for tummy tuck.

Why Get Abdominoplasty or Tummy Tuck?

An attractive and fit abdomen is the goal of most people. Despite diet and exercise, an improved abdominal contour is not always possible. Abdominoplasty (Tummy Tuck) is an operation that improves abdominal contour and profile by removing excess skin, stretch marks, and fat from the abdomen. At the same time, the weakened muscles of the abdomen are tightened and their position is restored. With age, pregnancy, or weight changes, patients develop diastasis rectus (separation of the abdominal muscles) with abdominal bulge. Diastasis rectus or diastasis recti cannot be corrected with exercises or physical therapy. Abdominal exercises actually cause the rectus abdominis muscles to separate further and worsen the diastsis, though it does improve the strength of other abdominal muscles. Repositioning the muscles can restore “core strength” and some studies have reported improved back pain and urinary continence.

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Abdominal Wall Reconstruction

This young woman had a particularly complicated form of abdominoplasty (tummy tuck) due to a past history of multiple abdominal operations as a child. Preoperatively (left), she had extensive scaring, many hernias and no obvious umbilicus (belly button). Activities that many of us take for granted, such as swimming, summer time in a bathing suit, or form fitting clothing, were a source of fear or embarrassment. Dr. Taylor and Dr. Sullivan made a plan for tummy tuck and complex abdominal wall reconstruction. Tissue expanders were placed (center) and slowly inflated over several months to stretch the skin of the upper abdomen. The scarred skin was then removed, the hernias repaired, and the belly button reconstructed. Several months postoperatively (right) a normal appearance has been restored and her life has been changed with scars hidden below underwear lines. She can now enjoy summer months and swimming with friends with few people knowing about her operation.

Mommy Makeover

"Mommy Makeover" describes a group of operations to restore a woman's body after having babies. The most common operations include tummy tuck, breast lift (mastopexy) or breast augmentation or both, labiaplasty, and liposuction. Sometimes operations are performed simultaneously on the same day if Dr. Taylor and Dr. Sullivan feel it is safe. Usually the procedures are separated by a few weeks as women recover.

Post-bariatric Surgery Body Contouring

Post-bariatric weight loss surgery with Dr. Taylor and Dr. Sullivan can restore your figure after you have successfully lost weight. If you have deflated areas of your body after weight loss, you may be a candidate for an operation with Dr. Taylor and Dr. Sullivan. Exercising and weight loss are important, but they can't remove excess skin or stretch marks. Only post-bariatric weight loss surgery can remove the excess skin. Patients often consider a tummy tuck (abdominoplasty) for removal of abdominal skin and fat, breast lift (mastopexy) for women to lift and make the breasts perky, gynecomastia surgery for men to create a masculine and muscular chest, arm lift (brachioplasty) to tighten the arms, or thigh lift to remove excess skin from the upper-inner legs. Each patient is carefully evaluated and if Dr. Taylor and Dr. Sullivan consider you to be a good candidate for an operation, they will customize a tailored surgical plan for your body. Dr. Taylor and Dr. Sullivan, Boston board certified plastic and cosmetic surgeons, work closely with the team at the Mount Auburn Hospital Weight Loss Center, where they give informational seminars to interested patients. It is never to early to consider your reconstructive options.

ABDOMINOPLASTY (Tummy Tuck) AFTERCARE INSTRUCTIONS

•       In the week before your operation:

o   Consider eating pineapple, it may help reduce bruising

o   Consider supplementing with Arnica montana, it may help reduce bruising

o   Complete household chores and prepare meals for the first few days of postoperative recovery

o   Follow preoperative instructions with eating, drinking, and medications

o   Order two compression garments specific to your size. The garments do not need to be expensive. Dr. Taylor and Dr. Sullivan can make some recommendations of garments that can be ordered from Amazon or online.

•       Postoperatively, get out of bed and walk (with assistance) every few hours after your operation to decrease the chance of postoperative problems such as blood clots.

•       Practice 15-20 deep breaths every hour to keep your lungs open.

•       After surgery, it is important for you to have someone available to stay with you for the first 24-48 hours, as you may feel drowsy. You may require help the first few times you get out of bed.

•       You may need to walk slightly “stooped over” (bent at the hips) for a few days to release tension on the suture line. When in bed keep your head elevated about 30 degrees (two pillows under your head and back) with the knees slightly flexed (one pillow under your knees).

•       Please take your medications as directed by Dr. Taylor or Dr. Sullivan to manage discomfort or symptoms.

o   Acetaminophen (Tylenol) 1000 mg every 8 hours, space doses 4 hours after Ibuprofen so one or the other is taken every 4 hours

o   Ibuprofen (Motrin) 800 mg every 8 hours, space doses 4 hours after Acetaminophen so one or the other is taken every 4 hours

o   Gabapentin 300 mg every 8 hours for 7 days

o   Vitamin C 500 mg daily for 50 days

o   Oxycodone 5 mg – 1-2 tablets every 6 hours as needed for pain, though many patients may not need it

o   Colace 100 mg twice daily to prevent constipation, it is important to have a bowel movement each day

o   Zofran 8 mg every 8 hours if needed for nausea

o   Scopolamine patch will be placed behind the ear on the day of surgery and can stay for 3 days

•       Eat a light diet for 2-3 days and avoid spicy food. Some suggestions to ease abdominal discomfort or indigestion after surgery:

o   Drink water or warm liquids

o   Prune juice to prevent constipation

•       The drainage bulbs connected to the end of the drains should be compressed at all times to keep suction. It is normal for red fluid and blood clots to form in the drains. Please record time and amounts of drainage over a 24-hour period – we will provide a form. Usually the drains will be removed when the drainage is 30cc or less in a 24-hour period. All patients heal differently and according to many factors. On average, drains remain for about one week.

•       You may shower or sponge bath the day after the operation with assistance and wash your skin as you normally would with soap and water. Avoid soaking the incision, although It will not hurt to get a splash of water on the wounds. Avoid submerging the drains. Gently pat dry after washing.

•       Wear the abdominal binder continuously for 3 weeks after surgery, then for 12 hours of each day for an additional 3 weeks, and thereafter as needed for comfort. You can take it off to shower. The binder helps control swelling and fluid build-up. If the binder rubs your skin, it can be worn over a soft t-shirt. We can provide suggestions for other types of binders to order as well.

•       Most wounds will be closed with absorbable sutures that are buried and skin glue. The skin glue forms a barrier to water. Please do not remove the glue, it will fall off on its own after a few weeks. Do not apply any lotions, potions, ointments, creams or solutions (e.g. no hydrogen peroxide or alcohol) as they can be harmful to the fragile healing tissue.

•       Do not smoke or expose yourself to smokers or nicotine as skin and wounds can be compromised.

•       Infection is uncommon, though please call Dr. Taylor or Dr. Sullivan immediately at any sign of infection which would be signaled by fever, increased pain, new redness or swelling in the abdominal area.

ACTIVITY

•       For the first few days following surgery, raising your blood pressure and heart rate can cause bleeding. Stress on your abdominal muscles or vigorous could stretch or break the stitches. We recommend walking 15 minutes 2 to 3 times per day and gradually increasing activity tailored to your recovery.

•       Please do not drive for 7 to 10 days or while taking pain medications such as oxycodone.

•       Do not lift anything heavier than 10 lbs, run, lift weights, or perform strenuous exercise for 6 weeks. You may begin having sexual intercourse 4 weeks postoperatively.

•       Massage to the areas of scar and liposuction can help increase circulation and soften firm areas under the skin. Please wait at least 3 to 4 weeks after surgery to start massage to avoid increased swelling.

GENERAL OUTCOMES

•       Moderate swelling and bruising is to be expected. This is most notable in the pubic region, above the incision, and in areas of liposuction. Bruising may last for a few weeks and will move down your body due to gravity.

•       The incisions often appear lumpy and bumpy. This is normal and the incisions will flatten over a few weeks.

•       You may find that your clothes may not fit as easily as before. Please be patient. And because of the removal of tissue from your abdomen, a feeling of tightness is to be expected. The swelling and feeling of tightness will gradually subside over the following months.

•       You may notice that you actually gain weight following liposuction. This is because the body retains fluid with swelling in response to the surgery. The swelling may persist for 6 weeks or more before it slowly decreases. A change in body contour and the way clothes fit is the goal of the operation, rather than a change or decrease in weight.

•       Tingling, itching, and numbness of the skin are all normal after liposuction. Tingling and itching are signs of healing and will resolve. Sensation usually returns gradually and slowly over weeks to months. Please be patient and avoid resting against hot surfaces, which can injure or burn the skin.

•       Scars take one full year to mature. You may notice that they become red, raised and firm for several weeks to months before becoming soft, flat and pale. Avoid Vitamin E as it can irritate the scar. Mederma has no proven benefit and is not worth the expense. Silicone cream or skin moisturizer with sunscreen and gentle massage may be helpful.

•       Infrequently after surgery you may have fluid in the abdomen after the drains are removed. If this happens, you will notice a fullness or sloshy feeling and may even have some drainage. Please contact our office so we can aspirate it easily.

•       A small amount bleeding from the incision is expected. Please call our office (617-492-0620) if you have:

o   Continuous bleeding

o   Significantly more swelling on one side when compared to the other

o   Worsening pain

o   Fever, spreading redness or irritation of the skin

o   Shortness of breath

It is important to be seen by Dr. Taylor or Dr. Sullivan after your operation. They will see you in follow-up appointments at 1 week, 2-4 weeks, 3 months, and 1 year or as often as needed post-op. Call Taylor and Sullivan Plastic Surgery to schedule your appointments at (617) 492-0620 between the hours of 8:30 – 5:00 or visit our webpage at www.massplasticsurgeons.com. We are always available for postoperative concerns or emergencies and can be reached through our paging service 24 hours per day at (617) 492-0620.

Download our Abdominoplasty (Tummy Tuck) postoperative instructions.